1 / 90

Gastrointestinal System

Gastrointestinal System. Assessment Techniques. History Medications Nutritional history Family history and genetic risk Current health problem Physical Examinations. Diagnostic Studies Upper GI Series. Before test: Maintain NPO for 8 to 12 hours before procedure

zilya
Download Presentation

Gastrointestinal System

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Gastrointestinal System

  2. Assessment Techniques • History • Medications • Nutritional history • Family history and genetic risk • Current health problem • Physical Examinations

  3. Diagnostic StudiesUpper GI Series • Before test: • Maintain NPO for 8 to 12 hours before procedure • Withhold analgesics and anticholinergics for 24 hr. • Patient drinks 16 ounces of barium. • Rotate examination table. • After the test: • Give plenty of fluids • Administer mild laxative or stool softener; stools may be chalky white up to 72 hours after test

  4. Lower GI Series • Barium enema enhances radiographic visualization of the large intestine. • Only clear liquids are given 12 to 24 hr before the test; NPO the night before; bowel cleansing is done. • After the test, expel the barium; drink plenty of fluids; stool is chalky white for up to 72 hours after test.

  5. Endoscopy • Direct visualization of the GI tract by means of a flexible fiberoptic endoscope

  6. Esophagogastroduodenoscopy • Visual examination of the esophagus, stomach, and duodenum • NPO 8 hours before the procedure • IV sedation • After the test, assessment of vital signs every 15 - 30 minutes • NPO until gag reflex returns • Throat discomfort possible for several days

  7. Endoscopic Retrograde Cholangiopancreatography • Visual and radiographic examination of the liver, gallbladder, bile ducts, and pancreas • NPO 8 hours before test • IV sedation • After the test, assessment of vital signs every 15 – 30 minutes • NPO until gag reflex returns • Assessment for pain

  8. Esophagogastroduodenoscopy/ERCP

  9. Capsule Endoscopy • Visualization of the small intestine • Dietary preparation similar to colonoscopy • Application of belt with sensors • 8 hours after swallowing capsule patient returns to have monitoring device removed • Peristalsis causes passage of the disposable capsule with a bowel movement

  10. Colonoscopy • Direct visualization of the entire colon with a flexible fiberoptic scope • Liquid diet for 24 to 48 hr before procedure, NPO for 6 to 8 hr before procedure • Bowel cleansing routine • Assessment of vital signs every 15 min • If polypectomy or tissue biopsy, blood possible in stool

  11. Other Tests • Computed Tomography (CT) • Magnetic Resonance Imaging (MRI) • Virtual Colonoscopy • Combines CT scanning or MRI with computer virtual reality software • No sedatives are needed and no scope is used

  12. Gastroesophageal Reflux Disease • Occurs as a result of the backward flow (reflux) of GI contents into the esophagus. • Reflux esophagitis characterized by acute symptoms of inflammation. • Esophageal reflux occurs when gastric volume or intra-abdominal pressure is elevated or the sphincter tone of the lower esophageal sphincter is decreased or is inappropriately relaxed.

  13. Clinical Manifestations • Pyrosis • Dyspepsia • Regurgitation • Hypersalivation or water brash • Dysphagia • Others manifestations—chronic cough, atypical chest pain, bloating, nausea and vomiting, hoarseness, sore throat

  14. Diagnostic Studies • Usually diagnosed on the basis of symptoms • Esophagogastroduodenoscopy (EGD) • UGI Series

  15. Collaborative Care • Lifestyle changes—elevate head of bed 6 inches for sleep and for 2 to 3 hours following a meal, stop smoking and alcohol consumption; reduce weight; wear nonbinding clothing; refrain from lifting heavy objects, straining, or working in a bent-over posture • Nutrition therapy • Patient education

  16. Drug Therapy • Histamine receptor antagonists decrease acid production. • Proton pump inhibitors provide effective, long-acting inhibition of gastric acid secretion. • Sucralfate (carafate) used for cytoprotective properties • Antacids neutralize hydrochloric acid (not effective in relieving symptoms or healing lesions)

  17. Peptic Ulcer Disease • PUD is a mucosal lesion of the stomach or duodenum caused when gastric mucosal defenses become impaired and no longer protect the epithelium from the effects of hydrochloric acid and pepsin. • Gastric and duodenal. • Acid, pepsin, and Helicobacter pylori infection play an important role in the development of gastric ulcers.

  18. Peptic Ulcers

  19. Gastric Ulcers • Most commonly found in the antrum • Risk factors include H. Pylori, medications, smoking and bile reflux

  20. Duodenal Ulcers • 80% of all peptic ulcers • Most duodenal ulcers occur in the first portion of the duodenum. • Development often associated with a high HCl secretion

  21. Clinical Manifestations • Dyspepsia • Pain • Silent peptic ulcers

  22. Complications of Ulcers • Hemorrhage—hematemesis • Perforation—a surgical emergency • Gastric outlet obstruction—manifested by vomiting caused by stasis and gastric dilation

  23. Collabrative CareDrug Therapy • One of the primary purposes for employing drug therapy is to eliminate or reduce pain. • Analgesics are not the mainstay of pain relief for PUD. • Ulcer drug regimen itself promotes relief of pain by eradicating Helicobacter pylori infection and promoting healing of the gastric mucosa.

  24. H2-Receptor Blockers • Promote ulcer healing • May be used for indigestion and heartburn • Block the action of the H2-receptors of the parietal cells, thus inhibiting gastric acid secretion • The most common—Zantac, Pepcid, and Axid

  25. Proton Pump Inhibitors (PPIs) • Prilosec • Prevacid • Aciphex • Protonix • Nexium • More effective than H2-receptor blockers in reducing gastric acid secretion and promoting ulcer healing

  26. Antibiotic Therapy • Treatment of H. Pylori is the most important element of treating peptic ulcer disease in patients’ positive for H. Pylori • Prescribed concurrently with a PPI or H2-receptor blocker

  27. Antacids • Adjunct therapy for PUD • Antacids buffer gastric acid and prevent the formation of pepsin; they are effective in accelerating the healing of duodenal ulcers. • The most widely used preparations are mixtures of aluminum hydroxide and magnesium salts, such as Mylanta or Maalox.

  28. Antacids (Cont’d) • For optimal effect, take about 2 hr after meals. • Antacids can interact with certain drugs and interfere with their effectiveness.

  29. Cytoprotective Drug Therapy • Sucralfate (Carafate) is a sulfonated disaccharide that forms complexes with proteins at the base of a peptic ulcer; this protective coat prevents further digestive action of both acid and pepsin.

  30. Nutrition Therapy • No specific recommended dietary modification • Avoid bedtime snacks. • Avoid alcohol, tobacco, caffeine-containing beverages and foods, and foods that commonly cause gastric irritation

  31. Potential for Gastrointestinal Bleeding • Interventions include: • Monitoring and early recognition of complications (critical to the successful management of PUD) • Preventing and/or managing bleeding, perforation, and gastric outlet obstruction • Possible surgical treatment

  32. Gastric Carcinoma • Infection with Helicobacter pylori is the largest risk factor for gastric cancer • Clinical manifestations—earlygastric cancer may be asymptomatic, but indigestion and abdominal discomfort are the most common symptoms.

  33. Gastric Carcinoma (Cont’d) • EGD with biopsy definitively diagnoses gastric cancer.

  34. Nonsurgical Management • Drug therapy: • Combination chemotherapy. • Radiation therapy: • The use of this treatment is limited because the disease is often widely disseminated upon diagnosis.

  35. Surgical Therapy • Vagotomy eliminates the acid-secreting stimulus to gastric cells and decreases the response of parietal cells. • Pyloroplasty facilitates emptying of stomach contents. • Billroth I and Billroth II

  36. Surgical Therapy (cont) • Deficiencies of vitamin B12, folic acid, and iron; impaired calcium metabolism; and reduced absorption of calcium and vitamin D develop as a result of partial removal of the stomach. • These problems are caused by a shortage of intrinsic factor.

  37. Surgical Therapy • Preoperative care is similar to that provided for general anesthesia and abdominal surgery. • Operative procedures include subtotal and total gastrectomy.

  38. Surgical Therapy (Cont’d) • Postoperative complications: • Hemorrhage • Dumping syndrome • Postprandial hypoglycemia • Bile Reflux gastritis • Reflux aspiration • Wound infection • Sepsis • Paralytic ileus • Bowel obstruction • Pneumonia • Anastomotic leak

  39. Gastrectomy

  40. Inflammatory Bowel Disease (IBD) • Several disorders of the GI tract with no known etiology • Ulcerative colitis • Crohn’s disease

  41. Ulcerative Colitis • Widespread inflammation of mainly the rectum and rectosigmoid colon; can extend to the entire colon • Associated with periodic remissions and exacerbations • Tenesmus • Loose stools containing blood and mucus, poor absorption of vital nutrients, and thickening of the colon wall can result • Increased risk for colon cancer

  42. Assessment • Clinical manifestations • Complications • Diagnostic studies

  43. Drug Therapy • Aminosalicylates • Antimicrobials • Corticosteroids • Immunosuppressants • Immunomodulators • Antidiarrheal drugs

  44. Surgical Therapy • Total colectomy • Total proctocolectomy with a permanent ileostomy • Postoperative care: • Loose, dark green liquid, with some blood in stool • Pouch system worn at all times • Skin care

  45. Crohn’s Disease • Inflammatory disease of the small intestine and the colon, or both. • It can affect the GI tract from mouth to anus but mostly the terminal ileum and colon. • Transmural inflammation causing thickening of the bowel wall with strictures and deep ulcerations with bowel fistulas commonly developing. • Rarely, cancer of the small bowel and colon develop. • Malabsorption of vitamins and nutrients.

  46. Fistulas

  47. Assessment • Clinical manifestations • Complications • Diagnostic studies

  48. Nonsurgical Management • Drug therapy • Nutritional therapy • Fistula management

  49. Skin Barriers

  50. Surgical Management • Approximately 75% of patients with Crohn’s Disease will eventually require surgery • Stricturoplasty

More Related